One of the problems is the way the Federal Government’s Department of Labor,does it is they don’t take into account those who, for various reasons, drop out of the job-seeking category. For example, Death and Debility, Retirement, and Discouragement and Preferred Dependency on Social Safety Net.

When those who have dropped out are added to the formula for estimating the Unemployment Rate, the Rate is closer to 8.35%.

I think the root cause of the problems President Obama had with his performance at the First Debate stem from the fact he really believes the charicature he and his team have been crafting of Gov. Romney. Their Strawman Romney never showed up for the Debate. That’s true. Never could. He only exists in their minds, their rhetoric and their TV Ads. So when the Romney of Reality showed up for the Debate, the President was miffed, distracted, befuddled. I found myself during the Debate saying “Get a grip Mr. President. Please!” Real Reality has a way of confounding one’s illusions and delusions. It seems the President unwittingly admits all this with his Next Morning double down campaign rhetoric based on his illusionary Strawman Version of Mitt Romney. See NYT story… After Debate, Obama Team Tries to Regain Its Footing link http://tiny.iavian.net/aah Or… is this all just in my mind?

This post is an attempt to explain how Medicare does now actually ration and limit medical care… and why the Independent Payment Advisory Board could function as a sort of “Death Panel”.

Understanding this is not easy… in fact, it is bewildering to many Medicare Beneficiaries and Doctors alike.

I know this as I have spend 20 some years as an Administrator for several Medical Practices. I have personally interacted with hundreds of Medicare Beneficiaries in the Real World of the Business of Medicine, who literally have been left to pay hundreds and thousands of dollars for their medical procedures and tests.

Let me try to explain…

Do you know what an ABN is? If you are covered by Medicare, you probably do (or at least should)!

ABN is the acronym for Advance Beneficiary Notice… A form that often is filled out by the doctor’s check-in person and handed to the Medicare Beneficiary to sign before they are ever seen by the doctor.

The ABN starts out at the top by stating: “If Medicare doesn’t pay for D. below, you may have to pay. Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the D. below.”

In essence the Notice says that when Medicare decides this procedure or diagnostic test is “not medically necessary” or “not a covered benefit”, then the Beneficiary is responsible to pay 100% of the charge for that procedure or test to the doctor.

Doctors are required by Medicare Regulations to prepare and present this ABN form to the Beneficiary in advance for the patient to review and sign when they believe Medicare may determine the procedure or test is “not medically necessary”.

The patient has Three Options:

1) I will have the procedure and will pay cash in advance for the procedure in case Medicare doesn’t pay.

2) I will have the procedure and pay for it… and don’t even send the bill to Medicare.

3) I don’t want to have the procedure because I don’t want to take the risk that i may have pay for it.

The most often response by patients when presented with an ABN is: “I have a Medicare Supplement Policy that pays for everything Medicare doesn’t.”

The truth is: Medicare Supplement Policies only pay for the 20% Patient Co-insurance portion of the Medicare Allowable amount of the charge. If Medicare refuses to pay anything, the Medicare Supplement policy is obligated to NOT pay anything either.

The most often response by patients when they are told this is: “But I was told it does.”

The truth of the matter is neither Medicare or Medicare Supplements are obligated to pay anything for procedures or tests (or Durable Medical Supplies for that matter) which Medicare determines is not medically necessary.

Sadly, many patients select Option 3 above. Then go home without receiving the care they and their doctor decided they needed… and bewildered, convinced that someone is lying to them.

It all hinges on who decides what is “medically necessary” and what is not.

The Independent Payment Advisory Board can ultimately decide what is “best practice”… what will be considered “medically necessary” and what is not.

I have seen the above scenario play out many, many times. I have personally helped patients who chose Option 1) to appeal unfavorable Medicare Coverage decisions. Sometimes Medicare reverses its decisions; many times they don’t. And the patient ends up responsible for paying the bill.

Often the patient comes into the doctor’s office (literally) begging to not have to pay. But the doctor is required to collect from the patient, and commits Medicare Fraud if they don’t.

If the patient can’t pay or refuses to pay, eventually the patient is sent to a Collections Agency. And then the dunning phone calls and letters start arriving demanding payment or worse.

Eventually, one or more of three things happens:

1) The patient pays… sometimes as little as $1.00 per month.

2) The patient doesn’t pay… and they are reported as such to the Credit Reporting Services.

3) The doctor doesn’t get paid, so they can’t pay their staff, can’t pay their bills… and so stops (or limits) seeing Medicare patients.

What are we to do? There are other good possibilities I believe. None of them involve “more government oversight or funding” of medical care.

Those possibilities will be the subject of future blog postings on So What… Commentary.

Well worth reading both the book and the review… especially for Rollins’ critique of Modern Christianity.

My opinion… Rollins gets much of the “diagnosis” of those portions of the Church which have been pressed into the mold of Modernity right, but his Postmodern “prescription” is both flat and harrow… and ultimately just another oppressive script with God Himself the victim.

Occasionally I am asked to recommend books on various subjects… Here one I read 25+ years ago and still think it is one of the current best on the subject.

I don’t agree with all of the points made and positions taken in the book by the Sandfords, but highly recommend it. This is NOT light reading, but an in-depth presentation of the Judeo-Christian position on how Human Beings work inside.

Continuing to think about how our unique sense of personal Identity molds, shapes, directs and (often) determines so much of our wondrous inner Life of the Mind… and the Wisdom of the Renewing of One’s Mind… to bring one’s beliefs about one’s self in synch with what is in fact really true about one’s self.

Putting Off the “Old”, Twisted Self

Renewing One’s Mind

Putting On the Wholly “New” (NOT Just an improved) Self

This requires being able to see True Reality with the Eyes of Your Heart. I’ll assume you are well schooled and proficient at this so we don’t need to go into all that now.

I learned an interesting think about Radiologists a few years back. You know, Radiologists are those doctors who can actually look at the inside of your body with x-rays, CT and MRI scans. They can quickly spot hairline fractures in bones, very, very small tumors in your brain, and lots of other “abnormal” stuff. How do they do it? They go to lots and lots of school to learn what is normal! So when they see something abnormal, it jumps right out at them. I know I am over simplifying what Radiologists do, but in a nutshell, this is how it works… because its the way our brains function best under the direction of our minds. Learn what’s “Normal”, and the “Abnormal” will be obvious.

So What… is the “New Normal” for the one who has had the Eyes of her or his Heart enlightened?

It comes as quite a revelation (and pleasant surprise to learn) for many that when they are “born from above”, they become at that exact moment in time wholly “new creatures”. Something dead in them is made alive, and they are given a New Identity.

It’s something like a old “dead” battery’s cells being refitted and recharged. The “New Normal” for the refitted and recharged battery is again full of Life”.

Those “born from above” get a New Heart from which New Faith and New Life spring forth in Hope and Love.

A new way of seeing True Reality with the Eyes of that New Heart, where time at times is timeless. The Future flows into the Present from the Past. This is the real nature of this World’s Reality… and, of course, it is only seen with Enlightened Eyes of the Heart.

But glimpses of this True Reality can be reflected in the “Born from Above” one’s thoughts, words and deeds for all to see, if they are looking for it… although they might not really understand what they are seeing.

The “Born from Above” one is also given a new Journey, but just like with physical birth, so with this New Birth from Above… we are born as babies, grow into infants, “teen-angers”, then young adults, then mature adults, and perhaps wise old women and men.

It takes a baby a while to learn how to effectively use its eyes, it’s brain, it’s arms and legs… so too with the Eyes of one’s New Heart. What normal babies do really well, even when just a few hours old, is crave milk! Born from Above ones are told “like newborn babies, [to] long for the pure milk of the word, so that by it you may grow…”.

This “word” we have is God’s actual voice speaking to us in and through the Scriptures. And just like a baby must learn to recognize his or her father’s voice, so too Born from Above ones must learn to recognize their Father’s Voice speaking through His Written Word.

As they do, they learn about Him and about themselves as New Creations… “who were born, not of blood nor of the will of the flesh nor of the will of man, but of God.” Truly unbelievable by those who don’t have the eyes to see this, or the ears to hear it.

What are some of the “New Normal” characteristics of the “New Me” who is “born of God”?

God has given me access to himself by the Holy Spirit (Ephesians 2:18)

God is building me, as one of his living stones, into a spiritual house (1 Peter 2:5)

God has made me part of the body of Christ and has given me specific spiritual gifts (1 Corinthians 12:27; Romans 12:6)

God has given me great and precious promises (2 Peter 1:4)

God will meet all my needs (Philippians 4:19)

God will give wisdom generously if I ask him (James 1:5)

God provides mercy and grace to help in my time of need (Hebrews 4:16)

God has given me a spirit of power, love, and self-discipline (2 Timothy 1:7)

God is able to keep me from falling (Jude 24)

God is strong in my weakness (2 Corinthians 12:9-10)

God has made me his ambassador (2 Corinthians 5:20)

God has made me a co-heir with Christ (Romans 8:17)

God is working all things together for the good of those who love him (Romans 8:28)

God will complete the good work he has begun in me (Philippians 1:6)

The Result

I belong to God (1 Peter 2:9)

I am one of God’s chosen people (1 Peter 2:9-10)

I cannot be separated from the love of God (Romans 8:35-39)

I am a new creation (2 Corinthians 5:17)

I am a child of the light and do not belong to the darkness (1 Thessalonians 5:5)

I am no longer a foreigner or an alien in God’s house (Ephesians 2:19)

I am a citizen of heaven (Philippians 3:20)

My life is hidden with Christ in God (Colossians 3:3)

I am a bondservant of Jesus Christ, pledged to obey him (Romans 6:16-18)

My body is a temple of the Holy Spirit (1 Corinthians 3:16)

I am holy, and I share in God’s heavenly calling (Hebrews 3:1)

When I confess my sins, God will forgive me and purify me from all unrighteousness (1 John 1:9)

I am made complete in Christ (Colossians 2:7)

I know that my work in the Lord is not in vain (1 Corinthians 15:58)

I am receiving a kingdom that cannot be shaken (Hebrews 12:28)

Taken from the Lysamena Project on Self-Injury. http://www.self-injury.org/identity.html

Quite a list. It takes most folks years to learn and accept this is their true New Normal.

But learning it deeply and widely enables them to readily recognize “Old Self” thoughts that are not consistent with their New Identity… and by an act of their will, choose to not accept that “Old Self” thought as true of them.

The majority of our thinking, our actions and our feelings just seems to spring from our sense of Identity. So as we understand and accept our New Identity, our thinking actions and feeling increasingly reflect naturally (effortlessly in large part) the New Me. Like having an “easy and light” yoke about us.

If I had to pick just one book that brings all this together, it would be Robert McGee’s The Search for Significance: Seeing Your True Worth Through God’s Eyes.

From the Introduction of John Paul II’s Encyclical Letter FIDES ET RATIO:

“In both East and West, we may trace a journey which has led humanity down the centuries to meet and engage truth more and more deeply. It is a journey which has unfolded—as it must—within the horizon of personal self-consciousness: the more human beings know reality and the world, the more they know themselves in their uniqueness, with the question of the meaning of things and of their very existence becoming ever more pressing. This is why all that is the object of our knowledge becomes a part of our life. The admonition Know Yourself was carved on the temple portal at Delphi, as testimony to a basic truth to be adopted as a minimal norm by those who seek to set themselves apart from the rest of creation as “human beings”, that is as those who ‘know themselves’.”

Knowing One’s Self is tricky business.

We want to know ourselves, and we don’t want to know ourselves. We hide from ourselves, as surely as Drug Mules hide in plain sight of those trying to stop them.

But… to be Human means to be, at some level, self-reflective. But often what we see in the mirror is not something we want to see. So we hide, we rationalize, we medicate, we escape, we fret, we deny, we beg forgiveness, we project, we self-justify, we consume, we try harder, we self-agrandize, we blame, we inflate, we deflate, we minimize, we lower our standards, we…whatever – ad nasium. My personal favorite thing to do is partake in some Retail Therapy… being able to spend money almost always makes me feel better about myself!

All of these things are so much a part of the story of so much of the whole Human Race… past and present. And one can probably rightfully expect it will continue to be so well into the future too. Life has become in so many ways, so often, a sub-human rat race of constant striving to just try to be good enough. By whose standards is unclear however.

Knowing one’s self is depressingly tricky business when everything depends on just the one looking in the mirror. The Truth we think we see in the mirror is simply too much to bear.

We promise ourselves Hope and Change, but what we often get is disappointment, discouragement and worsening same-o-same-o. Unless you live a charmed life where everything goes perfectly according to some plan. But there aren’t many who have this kind of life… despite what so much of the entertainment industry would have us believe. Although even that is changing with the invention of Reality TV shows. The false promises of Modernity are really fading.

So What… is one to do?

Consider one of the true, all-time Heroes of Life here on Plant Earth… a fellow who started off life known as Saul of Tarsus, and who became known as St. Paul.

Much has been written quite critical of Paul in the last few years. But most has been written from a postmodernist’s point of view… Oppressor-in-Chief of Women, Homophobic Religious Zealot Killjoy, Destroyer of the Real Jesus Meek and Mild. All of which can readily be debunked and dismissed as Invented Power Narratives by Lamed Victims of Modernity’s Self-serving Caricature of St. Paul seeking a way to explain (away) and hide their own Power Agendas. (We can go into this further someday if you want. At least for now you know how I really feel about it.)

Anyway… Paul is becoming newly respected and appreciated for what he wrote some 2,000+ years ago, as people today try to see their way through the morass of failed modern and hallow postmodern ideas about life.

One can see how Paul, in the context of his times, was both a clear-eyed and forceful social activist fighting against so much of the destructive reality around him, and a brilliant and insightful community organizer and mentor for those who literally “turned the world upside down”.

One of his most far-reaching and change-producing insights was his unique insight and understanding of how Human Beings actually work inside. Also, for Paul, Human Faith, Hope and Love have both a True Object and an Exact Content. These two things were what he (literally) spent his life talking (and writing) about… that is, if his friend Luke’s story about him (see Luke’s book The Acts of the Apostles) is anywhere near the mark. You decide.

So What… was Paul’s understanding of how Human Beings worked inside? The answer to this question is found, I’d suggest, by looking at what he actually wrote.

I quoted St. Paul at the end of my previous blog post on the Deconstruction of Personal Identity. Let me paraphrase and amplify that here. I have bolden the operative phrases for the purposes of this discussion.

“Therefore [based on the case for things I have made previously in this letter to you], I… implore you to conduct your lives in a manner worthy of the calling with which you have been called…. [for there] is… one hope… one Lord, one faith… [a] unity of the faith and knowledge…. As a result, [you will] no longer to be [like] children, tossed here and there by waves and carried about by every wind of [wrong thinking, and] by the trickery of others, [and] by the craftiness of their deceitful scheme.

…. conduct your lives no longer in the same manner as [those who choose to live their lives apart from this God], [that is,] in the futility of their mind, being darkened in their understanding... because of the ignorance that is in them, because of the hardness of their heart….

… in regard to your former manner of [conducting your] life, you [must therefore] 1) lay aside the old self, which is being corrupted, and that you 2) allow yourself to be renewed in the spirit of your mind, and 3) put on the new self, which [has been restored again to reflect] the image of God… in righteousness and… truth.” (Ephesians 4:1-24; my paraphrase and amplification)

Jumping right to the meat of the matter, Paul says there are three things incumbent on those whom desire to live a renewed life:

1) Lay aside the old self
2) Allow yourself to be renewed in the spirit of your mind
3) Put on the new self

So What… is this “Old Self” that Paul says must be laid aside?

I’d suggest it is an “old” Self Concept which we construct from wrong (misinformed) thinking and mis-interpretations of our life experiences, and those misrepresentations about ourselves that we (none the less) think are true about us. For example, “they think I’m dumb, ugly and stupid, therefore I must be dumb, ugly and stupid”.

Or on the other end of the spectrum: “they say I’m cute and Grandma’s Special Angel… therefore I AM more special and important than others and really should be treated like an angel who should always get whatever she wants when she wants it… so I really don’t need to eat my peas… besides, they aren’t MY peas, they are THEIR peas… I didn’t ask for them, did I? I’ll just say NO and close my eyes and mouth so tight they will never be able force me to eat THEIR peas! Who do they think they are anyway? Something is wrong with them. Don’t they know that I’m an Angel, and Angels don’t have to live by the same rules as mere mortals… so give me a break!).

In one word: FLESH.

When Paul uses the term “Flesh” in his letters, he uses it to denote two different things: 1) our physical bodies, as in “flesh and blood”; and 2) that combination of ideas/beliefs and physical/mental desires that are twisted, corrupted and anti-god… any god, but the god of Self. We each have our own unique version of “Flesh”… that which is in us that is in Rebellion Against God.

Consider now the other portion from Paul’s letter to the Corinthians I referenced previously (again, I have paraphrased [amplified] Paul and bolden the operative phrases):

“For though we live in the flesh [body], we do not war according to our [anti-god] flesh, for the weapons of the warfare [that goes on inside of us] should NOT be those of our [anti-god] flesh, but instead those that are divinely powerful for the destruction of [mental] fortresses [in our minds]. So we can destroy speculations and every lofty idea in our minds that is contrary to the true knowledge from God, and so we can take every thought captive to what is True in Christ…. If anyone is confident in themselves that they are Christ’s, let them consider this again within themselves…” (2 Corinthians 10:3-7 my paraphrase and amplification).

“… do not allow yourselves to be pressed into the anti-god pattern this twisted world, but be transformed by the renewing of your mind, so that you may live out what the will of God is for you… which is good and acceptable and you will find, perfect.” (Romans 12:2 my paraphrase and amplification).

The Middle Step in Paul’s Wisdom for Living Life on Planet Earth is the Renewing of One’s Mind… to bring one’s beliefs about one’s self in synch with what is in fact really true about one’s self.

That is the subject of Deconstructing Personal Identity – Part 3 to follow.

Hang on… This stuff is like learning a foreign language for many… because it is much like reading poetry in a foreign language. It is a kind of Wisdom Poetry. One often has to read and re-read, ponder and think much about it to see how (using the Enlightened Eyes of One’s Heart) it works together and makes sense. So hang on… And maybe even pray some and curse the darkness.